In the past surgical training could drag on for 14-15 years before someone would get their first consultant job. However during the last decade, surgical training in the UK has been shortened considerably since the introduction of reforms by Sir Kenneth Calman. Here's a timeline of the surgical career in the UK at present:
| POST | DURATION | DETAILS |
|---|---|---|
| House Officer (HO / PRHO) | 1 year | |
| Senior House Officer (SHO / BST) | 2 years minimum | Basic Surgical Trainee or BST. MRCS exam completed during these two years. Not much major "cutting" though apart from I&D of abscesses, appendicectomy, hernia repair, varicose vein stripping, orthopaedic MUA/screw insertion. |
| Variable additional years prior to getting a specialist registrar job | 0 to 4+ | Spent doing senior SHO or LAT jobs or getting a higher research degree like M.Sc or M.S. or Ph.D. Basically it's about getting some publications and national/international presentations in order to increase the chances of getting on the SpR interview shortlist. |
| Specialist Registrar (SpR / HST) | 6 years | Also called Higher Surgical Trainee or HST. Actual "cutting" learnt and during the final 2 years sub-specialisation is done. |
| Consultant | Permanent job | After 6 yrs of specialist registrar training one is eligible to apply for consultant jobs. |
In theory it is possible to become a consultant 9 years after graduation. In practice it is quite rare even for local graduates to achieve this. Most people will spend at least 1-2 years after their passing their MRCS Part II exam getting more clinical or research experience.
While some doctors do come immediately after graduating, most prefer to make the move either after their house job or after a variable number of years of surgical training. In fact it is not uncommon for people to have completed most of their surgical training in their home country prior to arriving in the UK. The best time to come depends on personal feelings and individual circumstances.
Some points nevertheless should be kept in mind. There is shortage of good house officer posts. Local graduates will be remembered from their undergraduate rotations and will be preferred by the consultants doing the short-listing.
Similarly there is also a shortage of specialist registrar posts (although surgical registrar numbers are due to increase during 2004). Doing one's SHO training in the UK enables the person to get known within the region, get to know the consultants doing the short-listing for the region and basically to understand the "politics" involved in getting a SpR job. Those coming to the UK after 4-5 years of overseas postgraduate training will inevitably end up spending 1-2 years "getting into the system" doing SHO jobs for which they may be over qualified. Some may find this frustrating.
Therefore coming to the UK after one's house job and applying for the more plentiful SHO jobs is to be recommended as it would also allow one to understand which hoops to jump through to grab a SpR post.
In order to work as a doctor in the UK registration with the General Medical Council is a legal requirement. An overseas doctor must have (or be eligible for) limited registration with the General Medical Council (http://www.gmc-uk.org/). There are three ways of doing this.
One way is to pass the PLAB test. About 71% of the 3658 overseas doctors who were given limited registration in 2002 did so via this route. There will be information available on our website (as well as at http://www.gmc-uk.org/register/plab.htm, http://www.gmc-uk.org/register/forms/plab.pdf and http://www.plabwise.co.uk) on how to do that. An overseas graduate can then potentially apply to a particular job depending on the amount of overseas training he/she has already done. For example, if he/she has already done a year of house job/internship in Pakistan then they could apply for SHO jobs straight away.
The other route to registration is sponsorship. Some 20% of linmited registrations last year were through this method.
The third route to registration is by completion of Basic Specialist Training to the satisfaction of the Royal College of Surgeons (6% of limited registrations in 2002). This means if a doctor has done at least 2 years of surgical training overseas (in addition to 1 year of house job) and passed the MRCS Part II exam in the UK he can start applying for jobs in the same way as people do after passing the PLAB test. The requirements are one year of internship/house job followed by 2 years of surgical training overseas which a royal college has deemed acceptable for exam purposes.
Many graduates are keen to do all their surgical training in the UK. For them the only approach to getting registered is to give the PLAB test straight after graduation or during their house job. If the doctor has passed the PLAB test and has started applying for jobs without completing one year of house job/internship work then they will be eligible for provisional registration and to apply for house jobs in the UK only. Those who have completed one year of house job and passed the PLAB test are eligible for limited registration with the GMC and can apply for SHO jobs.
Due to the unfair way things are currently set up by the GMC, passing the PLAB test does not automatically result in the GMC registering the doctor. Fortunately things may change with the proposed reform of the GMC registration process but it may be some time before the changes are implemented. So for the time being one has to apply for and actually get offered a job first before the GMC will register a doctor who has passed the PLAB.
It is legally possible to apply for HO/SHO jobs without being registered and then getting registered once a hospital offers the job. However the experience of most overseas doctors is that getting short listed for an interview is very unlikely prior to getting registered with the GMC.
Most doctors who have passed the PLAB test end up spending some weeks to months doing a clinical attachment in a surgical department. The idea is to familiarise the department with oneself and get offered a locum (i.e. temporary) SHO job in the same department. A consultant may then request the Personnel or Human Resources department to sign the GMC's Certificate of Selection for Employment (http://www.gmc-uk.org/register/forms/CSE.rtf) and get the person limited registration. Following this the person can start applying for surgical SHO jobs in earnest.
Now, a bit about the basic surgical exam in the UK. The FRCS exam was replaced by the MRCS (membership) and AFRCS (associate fellowship) exam a few years back. The training requirement was changed to from three to two years of work in a "training approved" job.
From January 2004 the individual college exams are being replaced by a new common Intercollegiate MRCS exam (http://www.rcseng.ac.uk/calendar/pdf/inter_exam_16apr03.pdf). While the all four royal colleges will continue to administer the MRCS, the actual exam being sat will be the same irrespective of the College or centre where it is held.
Many overseas doctors complete their surgical training in their home country. They then come to the UK, give the MRCS exam and then try to get "sponsorship" for Registrar level training. As surgical training at the Aga Khan University Hospital is approved for Basic Surgical Training this approach is feasible.
Then you will need sponsorship to get registered with the General Medical Council and start a registrar job.
Information received from the Royal Colleges (Aug 2003), suggests that the Royal College of Surgeons of Edinburgh will allow sponsorship for SHO jobs only- and that too if you have passed the Part I AFRCS/MRCS. I've attached some info on the Edinburgh Royal College Sponsorship scheme details.
The Royal College of Surgeons of England allows sponsorship for Registrar jobs mainly. What this means is that if you have passed the IELTS test, then you can apply for Type 2 registrar jobs (also known as FTTA or Fixed Term Training Appointments). If you get offered such a job then you can get registration with the GMC without doing the PLAB test (on the basis of sponsorship from the RCS England).
With a type 2 registrar job you will not get to be a consultant but will be able to work in the UK for 2-4 yrs. If you did want to get a 6-year Type 1 registrar job (which would allow you to get the Certificate of Completion of Specialist Training at the end of your 6 yrs) and become a consultant in the UK then you need to do the full MRCS/AFRCS exam. This could be done straightaway.
Secondly it can be done during the first year of a type 2 registrar job following which you can shift to a Type 1 job.
Thirdly you could try and get RCS Edin sponsorship for a SHO job after passing the Part I MRCS/AFRCS exam and keep doing SHO jobs till you get the Part II and then get a Type1 job.
The Intercollegiate Board Exam or "Part III" exam is sat towards the end of specialist registrar training (year 4+) and is beyond the scope of this article.
Following is an excerpt from Section A8 of the "Pink Book" available from the Joint Committee on Higher Specialist Training (which controls all the surgical Registrar jobs) http://www.jchst.org/pdf/pinkbook/pinkbook_sectionA.pdf.
Type 1 training programmes
The minimum entry requirements for appointment to a Type 1 HST programme leading to the award of the CCST are the MRCS/AFRCS/FRCS by examination or equivalent, and 24 months' approved basic surgical training (BST). At present the surgical royal colleges do not recognise any overseas qualifications as equivalent. Type 1 specialist registrars in oral and maxillofacial surgery must posses a registerable basic dental and medical qualification and the MRCS/AFRCS/FRCS. Trainees will normally be expected to acquire the MFDS (part C) within the continuum. If any of the required 24 months of BST has been undertaken outside the UK, evidence of satisfactory completion must be provided to the JCHST prior to enrolment/registration. It is expected that new entry criteria for HST will be published in the next year.
Type 2 training programmes
The criteria for entry to the grade and the arrangements for making an appointment to a Type 2training programme or fixed-term training appointment (FTTA) can be more flexible. However, the appointment procedures must assure the standard required for patient safety. In addition, whether appointed from within or outside the UK, doctors must:o be judged by the appointments committee to have attained a standard 'similar' although not 'equivalent' to that required for entry to the CCST training programme; ando demonstrate that they have the experience and qualifications to benefit from the training offered. Postgraduate deans may advertise separately and specifically for FTTAs within the SpR grade. Alternatively, in special circumstances, postgraduate deans may place overseas doctors in FTTAs without advertisement or open competitive appointment. The suggested criteria for defining 'similarity' is two years spent training in the generality of surgery, including at least six months in each of three SAC-defined specialties, a significant proportion of which must be spent working with surgical emergencies and/or care of the critically ill. Entry to Type 2 programmes in oral and maxillofacial surgery requires individuals to be in possession of both a medical and dental qualification. However, flexibility may still be required in the interpretation of 'similar qualifications' relating to the MRCS or MFDS examinations. Currently, Type 2 trainees wishing to obtain a Type 1 training post must have been awarded the FRCS/MRCS/AFRCS by examination and have completed 24 months' approved BST in order to be eligible for appointment to a Type 1 SpR post.
The latest jobs are published in the British Medical Journal's Classified Section every Friday. The online version is available every Thursday evening at http://www.bmjclassified.com/cgi-bin/section.pl?sn=1. Go into Hospital Appointments and check the House Officer or Senior House Officer or Registrar or Specialist Registrar boxes whichever is appropriate to the particular doctor. Tick the region(s) depending on preferences - although "Give Me Everything" would be recommended for a first job!
The specialties that are acceptable by the Royal Colleges for SHO jobs include Accident & Emergency, Cardiothoracic Surgery, Ear/Nose/Throat Surgery , General Surgery, Gynaecology (but not jobs combined with Obstetrics), Neurosurgery, Oral & Maxillofacial Surgery, Paediatric Surgery, Plastic Surgery, Trauma & Orthopaedics, and Urology. Further details on types of jobs acceptable for Basic Surgical Training are at http://www.rcseng.ac.uk/surgical/trainees/sho_bst/mrcs/pdf/regs_mrcs.
Basic Surgical Trainees need at least four 6-month jobs in different specialties. The old regulations classifying jobs as Category 1 and 2 are no longer being applied. Every Friday, a first time applicant would need to do a job search for each of the specialties listed above.
The interview short listing rate ranges between 5-15 % when first applying for SHO jobs in the UK depending on the quality of the CV.
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